Child Care Health Consultation (CCHC) in Rural Kentucky

1. Child Care Health Consultation (CCHC) in Rural Kentucky Tal Curry, LCSW Kentucky Dept. for Public Health

2. Commonwealth of Kentucky • 120 counties vary from small eastern county of Robertson (population 2,266) to Jefferson County/Louisville (693,604) predominately rural state, particularly the Eastern portion. • Many areas, primarily in Eastern Kentucky, remain isolated and distant from cities, universities, and services, and suffer from a shortage of health care professionals. • Approximately one-third of Kentucky is Appalachian region where significant health disparities exist. “ families with young children who reside in large rural areas are most likely impacted by the socio-emotional status of their children (National Survey of Children’s Health,2005)”

3. Appalachian Demographics • excess in mortality from leading causes of death vs. non-Appalachian U.S. • Many Appalachian counties with the most adverse health outcomes correlate geographically with socioeconomic characteristics, behavioral risk profiles, and available medical care resources. • lags economically in comparison to other parts of the U.S (high levels of unemployment, low regional incomes, educational deficits) RESULT • These factors place children at great risk for emotional and behavioral problems.

4. Early Childhood Demographics • 28% of children under the age of 6 live in poverty (45th) • 24% of KY children have special health care needs (50th) • Child care capacity 103,000 of 278,000 kids birth to five • 3rd highest rate of children who are overweight or at risk of overweight in the nation. • One in every three Kentucky kids are seriously overweight or at risk of becoming overweight. • One in three babies born in Kentucky in 2000 will develop diabetes during their lifetime. Reference: KIDS Count 2007 & Shaping Kentucky’s Future: Policies to Reduce Obesity; Partnership for a Fit Kentucky 2009. Source: CDC YRBS & PNSS 2007; National Governor’s Association Investing in KY’s Health National Governor’s Association Report on Healthy Living.

5. Kentucky Child Poverty

6. Barriers to Rural EC Services • Transportation • Access to medical care – only LHD, some family doctors few pediatricians • Workforce Development/Professional development • Culture of poverty – will they come in to get care? is it a value? • Young teen age families • How does this population define health? • Immunizations – some fear still exists and culture does not value • Prenatal care • Children with disabilities • Migrant population – growing population • Environmental conditions in workplace (air quality, lead exposure, clean water, etc) • Lack of funding due to low population vs. urban

7. Why focus on Child Care? During the first five (5) years, children of full time working parents may spend more time in out-of-home childcare facilities than their total hours spent at school from kindergarten to high school. (See math below) 260 (Annual work days) x 5 years = 13,000 hours 175 (Annual school days) x 12 years = 12,600 hours This makes it critical to utilize this “window of opportunity” to provide an environment at child care where children can thrive, through accurate health, nutrition and safety information to parents and child care providers.

8. What is Child Care Health Consultation (CCHC)? Staffed by health professionals (RN, Health Educator, Nutritionist) serve child care providers on health, safety, nutrition, and social/emotional well being • Consultation - onsite, telephone, and email • Technical Assistance • Community outreach, interagency collaboration, training, policy development, practice improvement, advocacy, health education, health promotion Goal is system change through consultations that involve policy change and trainings that demonstrate improved quality of care in centers • Effectiveness based primarily on-site targeted consultations to policies and staff competence. Effect is “dose-dependent.” i.e., more frequent consultations result in more positive outcomes. National Training Institute for CCHC – North Carolina Standards in Caring for Our Children published as a consensus document from American Public Health Service, the American Academy of Pediatrics, and the Maternal and Child Health Bureau of HRSA. Free web site http://nrc.uchs.edu

9. Current Model CCHC Model • Implemented in July 2000, Healthy Start in Childcare is a KIDS NOW Initiative (i.e., funded with $ from the Master Tobacco Settlement) • 88 local consultants in 56 LHD most serving 3000 child caring providers • Strengths • LHD use some local funds • Local relationships with child care providers • Social and emotional DECA Program • Offer early childhood training hours to providers • Barriers • Part time staff • Poor data collection system through state health dept system • Nursing staff often pulled for clinic due • Limited state funds meant majority of rural LHD got less than $5000 to fund a program • What measurable difference can be demonstrated on low funds? • Poor supervisory/technical assistance system for consultant • Inconsistent information given to providers

10. New CCHC Model • Build on existing strengths • RFA for 10-12 (1.0FTE) statewide consultants from LHD to target consultation. • New web based data system • 1800 Helpline to provide technical assistance to statewide consultants and all 3000 child care providers • Goal to build on existing strengths of 10-12 existing consultants. • Redefine health to include SE well being, oral health, obesity-physical exercise • Workforce development – train the trainer- NTI, playground safety inspections, ASQ:SE knowledge, DECA, CSEFEL

11. System of Care Partners Build on existing strengths and relationships: • Child Care Resource and Referral Agencies • Community Early Childhood Councils • CMHC- Early Childhood Mental Health Specialists & Perinatal Depression Contacts • IMPACT wraparound service coordination • HANDS- Home visiting program for prenatal to age 2 • First Steps – KY Early Intervention Services • Early Head Start & Head Start • Division of Regulated Child Care/office of the Inspector General • STARS Quality Enhancement Initiative • Ky Injury Prevention Center • Partnership for a Fit Kentucky • Commission for Special Health Care Needs • Kentucky Partnership for Families and Children (Family Federation) & other family advocates, parent support groups • Child Welfare – Child care assistance, Medicaid, Family Preservation Program, FINSA cases • Faith- based community

12. KIDS NOW Initiative • The goal of KIDS Now is to ensure all young children in Kentucky are healthy and safe, possess the foundation that will enable school and personal success, and live in strong families that are supported and strengthened within their communities. • A most recent evaluation of the KIDS NOW program indicates early care and education centers scored the lowest in the area of “Health and Safety” on the Environmental Rating Scales.

13. Important Collaborative Partners • Child Care Resource and Referral delivers technical assistance to child care providers, both current and those seeking licensure, employers seeking information on how they can better meet the child care needs of their employees and community members seeking information on child care in general.  • The Quality Enhancement Initiative provides technical assistance to child care providers seeking STARS for KIDS NOW rating. • Division of Regulated Child Care/Office of the Inspector General –licensing and regulation defeciences

14. ECMH Program • Initiated FY 2003, one of last KIDS NOW components to be implemented • Designed to build upon existing ECMH & Child Care Health Consultation efforts • Co-administered by Dept for Public Health and Dept for Mental Health • Funding for one ECMH Specialist in 14 CMHC for direct services • Providing observation; consultation; assessment; clinical services; resource sharing; training, and community collaboration and planning for children age 0-5 and their families. • Program and child-level consultation to child care programs regarding social, emotional, and behavioral issues • Training on working with young children with social, emotional, and behavioral needs and their families to child-serving agencies and individuals • Evaluation, assessment, and therapeutic services for children 0-5 and their families.

15. HANDS • Voluntary home visitation program for at risk first time parents in order to promote the healthy growth and development of the child. • PREMATURITY - 35% LESS THAN FAMILIES AT-RISK; 12% LESS LIKELY STATEWIDE • LBW - 32% LESS THAN FAMILIES AT-RISK; 9% LESS LIKELY STATEWIDE • VLBW - 49% LESS THAN FAMILIES AT-RISK; 23% LESS LIKELY STATEWIDE • INFANT MORTALITY - 69% LESS LIKELY THAN STATEWIDE • ER VISITS - 50% LESS LIKELY THAN STATEWIDE • DEVELOPMENT DELAY - FEWER CHILDREN WITH DEVELOPMENTAL DELAYS

16. Resources • www.aap.org • www.healthychildcare.org • www.healthychildcarenc.org • www.healthychild.net Kentucky • http://mhmr.ky.gov/mhsas/ECMH%20Training.asp • http://chfs.ky.gov/dph/mch/ecd/hands.htm • http://www.education.ky.gov/KDE/Instructional+Resources/Early+Childhood+Development/KIDS+NOW+Initiative.htm